Head Computed Tomography Scans in Elderly Patients with Low Velocity Head trauma after a Fall.
Accidental Falls
/ statistics & numerical data
Aged
Brain Injuries, Traumatic
/ diagnosis
Craniocerebral Trauma
/ diagnosis
Emergency Service, Hospital
/ statistics & numerical data
Facial Bones
/ injuries
Facial Injuries
/ diagnosis
Female
Humans
Intracranial Hemorrhages
/ diagnosis
Israel
/ epidemiology
Male
Neurologic Examination
/ methods
Neurosurgical Procedures
/ methods
Procedures and Techniques Utilization
/ standards
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Tomography, X-Ray Computed
/ methods
Unconsciousness
/ diagnosis
Journal
The Israel Medical Association journal : IMAJ
ISSN: 1565-1088
Titre abrégé: Isr Med Assoc J
Pays: Israel
ID NLM: 100930740
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
entrez:
22
6
2021
pubmed:
23
6
2021
medline:
2
7
2021
Statut:
ppublish
Résumé
Recommendations for a head computed tomography (CT) scan in elderly patients without a loss of consciousness after a traumatic brain injury and without neurological findings on admission and who are not taking oral anticoagulant therapy, are discordant. To determine variables associated with intracranial hemorrhage (ICH) and the need for neurosurgery in elderly patients after low velocity head trauma. In a regional hospital, we retrospectively selected 206 consecutive patients aged ≥ 65 years with head CT scans ordered in the emergency department because of low velocity head trauma. Outcome variables were an ICH and neurological surgery. Independent variables included age, sex, disability, neurological findings, facial fractures, mental status, headache, head sutures, loss of consciousness, and anticoagulation therapy. Fourteen patients presented with ICH (6.8%, 3.8-11.1%) and three (1.5%, 0.3-4.2%) with a neurosurgical procedure. One patient with a coma (0.5, 0.0-2.7) died 2 hours after presentation. All patients who required surgery or died had neurological findings. Reducing head CT scans by 97.1% (93.8-98.9%) would not have missed any patient with possible surgical utility. Twelve of the 14 patients (85.7%) with an ICH had neurological findings, post-trauma loss of consciousness or a facial fracture were not present in 83.5% (95% confidence interval 77.7-88.3) of the cohort. None of our patients with neurological findings required neurosurgery. Careful palpation of the facial bones to identify facial fractures might aid in the decision whether to perform a head CT scan.
Sections du résumé
BACKGROUND
BACKGROUND
Recommendations for a head computed tomography (CT) scan in elderly patients without a loss of consciousness after a traumatic brain injury and without neurological findings on admission and who are not taking oral anticoagulant therapy, are discordant.
OBJECTIVES
OBJECTIVE
To determine variables associated with intracranial hemorrhage (ICH) and the need for neurosurgery in elderly patients after low velocity head trauma.
METHODS
METHODS
In a regional hospital, we retrospectively selected 206 consecutive patients aged ≥ 65 years with head CT scans ordered in the emergency department because of low velocity head trauma. Outcome variables were an ICH and neurological surgery. Independent variables included age, sex, disability, neurological findings, facial fractures, mental status, headache, head sutures, loss of consciousness, and anticoagulation therapy.
RESULTS
RESULTS
Fourteen patients presented with ICH (6.8%, 3.8-11.1%) and three (1.5%, 0.3-4.2%) with a neurosurgical procedure. One patient with a coma (0.5, 0.0-2.7) died 2 hours after presentation. All patients who required surgery or died had neurological findings. Reducing head CT scans by 97.1% (93.8-98.9%) would not have missed any patient with possible surgical utility. Twelve of the 14 patients (85.7%) with an ICH had neurological findings, post-trauma loss of consciousness or a facial fracture were not present in 83.5% (95% confidence interval 77.7-88.3) of the cohort.
CONCLUSIONS
CONCLUSIONS
None of our patients with neurological findings required neurosurgery. Careful palpation of the facial bones to identify facial fractures might aid in the decision whether to perform a head CT scan.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM